Journal Entry 3: HIV/AIDS - Initial Impressions

Do not underestimate the power of denial. (A Course In Miracles)

One of the most telling examples of the state of HIV/AIDS in black South Africa happened during an HIV/AIDS session with our language trainers (teachers are called “trainers” in South Africa). I asked, “Do you know the HIV rate in South Africa?”

The trainer responded, “No.”

“Well, do you know if it's relatively high or low?”

“Low. Maybe 10%.”

“Actually,” I said, “I've heard figures somewhere between 20 to 40%.”

“Yes, well, like I said, it is low. Definitely below 50%.”

The person who said that is far from stupid. This is simply the state of HIV in South Africa: a superficial awareness of the endemic undermined by a deeper lack of understanding of HIV, it's scope and severity. As a friend pointed out, “There is a difference between information and education.” South Africa is swimming in the former, the latter is in scarce supply.

Later that day, again with our trainers, someone brought up the issue of life expectancy. A trainer said he thought life expectancy was long in South Africa, maybe on average 65. Despite there being a number of other trainers in the room, no one offered another more reasonable figure and I felt I had to correct him.

In general the issue of HIV/AIDS in South Africa is “discussed” macroscopically: you see the billboards and news programs on HIV, but little to nothing is said on a community level. And because nothing is discussed in the community, the information people do have never becomes integrated into their lives, and the transition from information to knowledge is not made. From person to person, knowledge becomes asymmetrical and often a superficial understanding becomes used to mask a latent ignorance. So long as ignorance remains, so will HIV.

As a case in point, while I was in Venda, my permanent site, this past week I ate lunch with the assistant principal at her school – one of four I'll be working with. While we were eating, a young man from “Lava Life”, an enigmatic HIV awareness program, stopped by. After their discussion, the assistant principal asked me if I would write a short story about HIV. Despite her numerous requests I declined, as she intoned that the kids may write one. However, it came to light that she had already written a story called “HIV, Your Time Is Up”. I asked her if I could see it and she gladly let me. I was sad to see her description of the disease really missed the mark, stating a person could contract HIV by sharing pencils or sitting in the same chair and not mentioning nothing about HIV being a sexually transmitted disease. In light of this, I wrote a one page declaration of sorts also called “HIV, Your Time Is Up!”

HIV is not discussed because of the stigma that is attached to the disease. In fact, the stigma is so strong that parents let their child die of “pneumonia” rather than taking them to the clinic to test for the disease. And the government will provide anti retro viral (ARV) medication to people with CD4 counts below 200. But HIV is the scarlet letter of South Africa: if the community finds out you have it you are different, you are branded and people will want to have nothing to do with you. To them, it is not a disease, there is something wrong with you. So people die because they are “sick”, and that is all that is ever said.

There are many external reasons why the tide has not turned on the spread of the disease. I don't pretend to know all of them, but there are two I should comment on: First, in a deeply Christian culture where God is very much aware of good guys and bad guys, religion has not helped. It serves to both reinforce the stigma of HIV (if you have it, you are a sinner who is out of favor with God) and discourages people from getting tested (after all, if I pray to Jesus to he will save me and getting tested could almost been seen as a heresy or lack of faith).

But more than religion, South Africa's leaders have failed them. In a tribal or collectivist culture where elders are deeply revered, enough cannot be said about South Africa's leaders lack of leadership. And specifically Thabo Mbeki, the president, needs to be singled out. While he has done excellent things in moving the South African economy forward and in building an African community that is beginning to look to itself for answers to the continent's problems, he is also doing a disservice to his country by not clearly addressing HIV. I cannot tell you how much more influence he has on people's perception of the endemic due to his status than all the grassroots movements combined. And because their leaders have not been vocal in supporting HIV awareness (in fact, Mbeki reportedly said HIV does not cause AIDS) the information that does reach the general populous is not supported, is hallow and, frankly, gets laughed at.

And up to this point, I'm sorry to say, I think that the Peace Corps has handled HIV/AIDS training poorly. We've had some discussions about the epidemic, but nothing that highlights its severity and give us tools to transfer our knowledge to our communities. Instead, the African ambivalence seems to be seeping into our mindset, too. After all, life is still going on all around you – kids go to school, parents are off to work, and the usual problems of money, careers and romance seem more pressing, and more fun, to talk about. Were it not for all the funerals, you would think everything was fine. But, of course, it's not. While on one level I think you need a degree of acceptance to go on with your life, on another you certainly don't. I hope the PC will get around to that other level soon.

But, at the end of the day– ...well, let me put it like this: There are no funeral processions in South African culture but these days there is certainly a procession of funerals. On the weekends people go to weddings and funerals, on the weekdays they only go to funerals. Not everyday and every week, but often and too often. Ultimately the people are responsible for the spread of the disease; not religious groups or the government or the odd Peace Corps volunteer. Then I must ask myself the question when, as individuals and as a nation, will the people's outrage at the disease - so long denied - finally surpass their tolerance for it? Because in 2010 when the earth's most popular sporting event, the World Cup, comes to South Africa and turns the world gaze to this beautiful country I cannot help but wonder who will be left to see it?